3. Pharmacy Practice for the CPhT: Issues That Require Pharmacist Intervention

What is the main rule for deciding when to involve the pharmacist?

Refer any issue that requires clinical judgment or decision-making.

What should a technician do when a situation exceeds their scope of practice?

Recognize the concern, document relevant facts, and refer it to the pharmacist.

What does DUR stand for?

Drug Utilization Review.

What is the purpose of DUR?

To evaluate whether prescribed medications are safe and appropriate for the patient.

What problems can DUR identify?

Drug interactions, incorrect doses or duration, duplicate therapy, allergies, contraindications, and monitoring needs.

What is therapeutic duplication?

Unnecessary overlap in medications used for the same or similar therapeutic purpose.

Who must evaluate and resolve clinical DUR concerns?

The pharmacist.

Can a technician independently decide that a drug interaction alert is clinically unimportant?

No; the pharmacist must evaluate the alert.

How do technicians support DUR?

Enter accurate patient information, medication histories, and allergy records, and flag concerns.

What does ADR stand for?

Adverse drug reaction.

What is an adverse drug reaction?

A harmful or unintended response to a medication taken at recommended doses.

What should a technician do when a patient reports a possible adverse drug reaction?

Promptly alert the pharmacist and accurately relay the reported symptoms.

Who assesses the severity of a suspected adverse drug reaction?

The pharmacist.

Can a technician independently recommend a dose change because of a side effect?

No; refer the concern to the pharmacist.

What safety reporting program may receive reports of serious or unusual medication reactions?

MedWatch.

Who may provide medication counseling in the workflow described in the notes?

A pharmacist or an authorized pharmacy intern under pharmacist supervision.

Can pharmacy technicians provide medication counseling?

No.

What medication questions require counseling by the pharmacist?

Questions about use, dosing, side effects, interactions, storage, missed doses, or treatment effectiveness.

What should a technician do if a patient asks what to do after missing a dose?

Refer the patient to the pharmacist.

What should a technician do if a patient asks whether to take a medication with food?

Refer the patient to the pharmacist.

How can technicians support patient counseling?

Ask whether patients have questions, notify the pharmacist, and connect patients with counseling.

What does OBRA-90 stand for?

Omnibus Budget Reconciliation Act of 1990.

What three pharmacy responsibilities are emphasized by OBRA-90 in the notes?

Drug utilization review, maintaining patient records, and offering patient counseling.

Which patients are covered by the federal OBRA-90 counseling requirements described in the notes?

Medicaid patients; state requirements may extend counseling obligations to other patients.

What important information should patient profiles contain?

Current medications, allergies, and relevant medical conditions.

What is therapeutic substitution?

Replacing a prescribed medication with a different drug intended to produce a similar therapeutic effect.

What is another name for therapeutic substitution?

Therapeutic interchange.

What is generic substitution?

Replacing a brand-name medication with an equivalent generic containing the same active ingredient, strength, and dosage form.

How does therapeutic substitution differ from generic substitution?

Therapeutic substitution changes the drug; generic substitution uses an equivalent version of the same drug.

What are common reasons to consider therapeutic substitution?

Cost, medication shortages, and insurance formulary restrictions.

What is a formulary?

A health plan's list of covered or preferred medications.

Who evaluates and recommends therapeutic alternatives within the pharmacy team?

The pharmacist.

Does a medication shortage allow a technician to independently choose a different drug?

No; refer to the pharmacist for review and required authorization.

What authorization may be needed before a therapeutic substitution?

Prescriber approval or an applicable authorized protocol, depending on law and setting.

How can a technician help with therapeutic substitution?

Identify stock or insurance problems and alert the pharmacist.

What is medication misuse?

Taking or using medication in a way that differs from the prescribed instructions.

Can medication misuse be unintentional?

Yes; it may result from confusion or misunderstanding.

What are examples of medication misuse?

Taking extra doses, stretching a prescription by taking less, or using medication to get high.

What risks can medication misuse create?

Treatment failure, harmful effects, dependence, and overdose.

What refill pattern may suggest medication misuse?

Unusual refill timing or repeated early refill requests.

Does an unusual refill pattern prove medication misuse?

No; it is a concern for the pharmacist to evaluate.

What should a technician do when medication misuse is suspected?

Share the relevant facts with the pharmacist promptly and without judgment.

What does VAERS stand for?

Vaccine Adverse Event Reporting System.

What is the purpose of VAERS?

To collect reports of adverse events after vaccination and help identify potential safety concerns.

Which agencies jointly manage VAERS?

The CDC and FDA.

Who can submit a report to VAERS?

Anyone, including patients, caregivers, technicians, and healthcare professionals.

Does a VAERS report prove that a vaccine caused the event?

No.

Must vaccine causation be proven before an event can be reported to VAERS?

No.

What should a technician do when a patient reports a possible vaccine reaction?

Document the information and promptly refer the clinical concern to the pharmacist.

What are the three main interaction types discussed in the notes?

Drug-drug, drug-food, and drug-disease interactions.

What is a drug-drug interaction?

One medication changes the effects of another medication.

What is a drug-food interaction?

A food or beverage changes a medication's absorption, metabolism, elimination, or effects.

What is a drug-disease interaction?

A medication can worsen an existing medical condition.

What does DDI stand for?

Drug-drug interaction.

What is the major concern when warfarin and aspirin are combined?

Increased bleeding risk.

Is warfarin plus aspirin always an error?

No; it may be prescribed intentionally, but requires clinical evaluation and monitoring.

What can happen when spironolactone is combined with potassium supplements?

Hyperkalemia, or high blood potassium.

What can happen when benzodiazepines are combined with opioids?

Dangerous sedation and respiratory depression.

What benzodiazepine example is listed in the notes?

Diazepam.

How can grapefruit affect some statins?

It can reduce their breakdown and increase drug levels and toxicity risk.

Does grapefruit interact equally with every statin?

No; the specific medication and other factors matter.

What should a technician do when asked whether grapefruit is safe with a medication?

Refer the question to the pharmacist for product-specific guidance.

What serious muscle-related adverse effect can occur with elevated levels of some statins?

Rhabdomyolysis, or muscle breakdown.

How can dairy products affect tetracycline absorption?

They can reduce absorption.

What food interaction is associated with monoamine oxidase inhibitors (MAOIs)?

Tyramine-rich foods, such as aged cheeses, can cause dangerously high blood pressure.

Why can beta-blockers be a concern in patients with asthma?

They can narrow the airways and worsen asthma, particularly nonselective agents.

Why is aspirin a concern in patients with peptic ulcer disease?

It can increase gastrointestinal irritation and bleeding risk.

Who evaluates whether an interaction requires a dose change, alternative drug, or additional monitoring?

The pharmacist.

What is medication adherence?

Following prescribed medication instructions, including dose, timing, and duration.

What can poor medication adherence cause?

Treatment failure, worsening disease, and hospitalization.

What are common barriers to medication adherence?

Cost, side effects, forgetfulness, and complicated regimens.

What refill patterns may suggest poor adherence?

Late pickups, missed refills, or gaps in therapy.

What should a technician do after noticing a possible adherence problem?

Document the concern and notify the pharmacist.

What tools may support medication adherence?

Appropriate pill organizers, reminders, and refill synchronization.

What is refill synchronization?

Coordinating refill dates so multiple prescriptions can be refilled together.

Who evaluates whether a medication regimen should be simplified?

The pharmacist, with any required prescriber involvement.

What does MPR stand for?

Medication possession ratio.

What does MPR help estimate?

Medication adherence based on medication supply over time.

Who evaluates allergy severity and its effect on medication selection?

The pharmacist.

What allergy information should technicians collect and document?

The reported allergen and details of the reaction.

What should a technician do when a patient reports a new allergy?

Update the record according to policy and promptly alert the pharmacist.

Can inactive medication ingredients cause allergic reactions?

Yes; dyes, preservatives, fragrances, and other ingredients may matter.

What types of allergies can affect medication selection?

Medication, food, dye, and topical ingredient allergies.

What is anaphylaxis?

A severe, potentially life-threatening allergic reaction requiring emergency care.

Can a technician independently decide that a documented allergy is safe to ignore?

No; refer it to the pharmacist.

Can a technician explain insurance copays or medication costs?

Yes; these are nonclinical operational questions.

Can a technician explain the administrative steps of prior authorization?

Yes, within their role and pharmacy policy.

Can a technician tell a patient whether a medication is in stock?

Yes.

Can a technician tell a patient how many refills remain?

Yes.

Can a technician update a patient on prescription status?

Yes.

Can a technician help a patient locate an OTC product?

Yes; locating a product is different from recommending treatment.

Can a technician recommend which OTC medication a patient should take?

No; refer treatment recommendations to the pharmacist.

What should a technician do when a patient says a medication is not working?

Refer the concern to the pharmacist.

What information makes a pharmacist handoff useful?

The patient's question or symptoms and relevant medication, allergy, refill, or insurance details.

What should technicians avoid when referring a clinical concern?

Diagnosing, recommending therapy changes, or dismissing the concern.